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Drug resistance (DR) to antituberculosis drugs is a growing global problem that threatens the successful control of tuberculosis (TB) globally and within the Gulf Cooperation Council (GCC). In the GCC, TB remains a major public health issue. Understanding the prevalence and patterns of drug resistance to antituberculosis drugs is crucial for developing effective prevention and treatment strategies. Hence, the present systematic review is aimed at assessing the prevalence, pattern, and risk factors of drug-resistant TB (DR-TB) in GCC countries. We conducted this systematic review adhering to the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 Statement. Using the relevant keywords in the major databases, we included peer-reviewed articles that were published from 01 January 2014 and onwards in English language journals. The prevalence and patterns of DR-TB levels in different countries were different. Isoniazid monoresistance was the most commonly found type of resistance, with varying degrees of prevalence of multidrug-resistant tuberculosis (MDR-TB). Risk factors for DR-TB included diabetes mellitus, past TB treatment, younger age, female gender, and renal failure. There was a positive correlation between expatriate status and DR-TB. Collaborative actions by relevant stakeholders are essential to implement evidence-based interventions that reduce the DR-TB burden and improve overall community health. Ongoing research and surveillance activities are necessary for monitoring patterns, identifying new risk factors, and providing focused interventions to lessen the threat of DR-TB on public health in GCC countries.

BackgroundAutologous flaps may have superior outcomes when compared to implant breast reconstruction in patients with obesity. To date, no published review has illustrated the superiority of autologous to implant-based reconstruction in this study group in terms of aesthetics outcomes and surgical complications.MethodsA systematic search was conducted on PubMed, Cochrane, Google Scholar, and Embase from inception to December 31, 2020. Studies comparing the outcomes (patient satisfaction and complications) of autologous versus implant-based reconstruction in patients with BMI > 30 were selected.ResultsThe search yielded 1633 articles, of which 76 were assessed in full text. A total of 12 articles fit inclusion for qualitative review; of them, 7 were meta-analyzed. Autologous reconstruction had a lower incidence of infection (OR 0.74 [95% CI 0.59, 0.92]), hematoma/seroma formation (OR 0.34 [95% CI 0.23, 0.49]), and reconstructive failure (OR 0.47 [95% CI 0.36, 0.62]), but not skin necrosis (OR 0.95 [95% CI 0.73, 1.25]) or wound dehiscence (OR 1.03 [95% CI 0.72, 1.49]) when compared to implant-based reconstruction. Deep vein thrombosis (DVT) and pulmonary embolism occurred more frequently with autologous versus alloplastic reconstruction (OR 2.21 [95% CI 1.09, 4.49] for DVT and OR 2.49 [95% CI 1.13, 5.48] for PE). BREASTQ scores were higher for the autologous breast reconstruction when compared to implant-based group, but failed to reach significance (p value >0.05).ConclusionThe current evidence in the literature suggests that autologous breast reconstruction has lower surgical complication rate when compared to implant-based reconstruction at the expense of higher risk of thrombotic complications for patients with BMI > 30.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background: Acinetobacter baumannii (A. baumannii), a critical nosocomial pathogen, poses a significant threat in intensive care units (ICUs) due to its multidrug-resistant (MDR) strains. This study systematically reviews and performs a meta-analysis on the prevalence and antibiotic resistance profiles of MDR A baumannii (MDR-A. baumannii) in ICU patients in Saudi Arabia. Methods: A comprehensive search in PubMed, Saudi Digital Library, Scopus, and Web of Science, focusing on studies from January 2014 to September 2025, was performed. The present study followed the reporting guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-2020). Data on study characteristics, sample sizes, patient demographics, prevalence of MDR-AB, and antibiotic resistance profiles were extracted and analyzed. Quality assessment was conducted using the Joanna Briggs Institute. Results: The prevalence of MDR-AB in ICU patients varied significantly across studies, with retrospective studies reporting rates from 3.37% to 69% and prospective studies ranging from 3.9% to 72.73%. Colistin remained highly effective, showing 100% susceptibility in some studies. Meanwhile, resistance to carbapenems like imipenem and meropenem often exceeds 50%. Additional antibiotics with notable resistance included gentamicin, tigecycline, ampicillin/sulbactam, trimethoprim-sulfamethoxazole, ceftazidime, piperacillin/tazobactam, and third-generation cephalosporins. Mechanisms of resistance frequently involved OXA-type carbapenemases, particularly OXA-23. While OXA-23 was the most frequently detected carbapenemase, recent genomic data have also revealed the presence of metallo-β-lactamases, such as IMP-type genes, in ICU isolates. Conclusions: MDR-A. baumannii poses a substantial challenge in Saudi Arabian ICUs, with high prevalence and significant resistance to commonly used antibiotics. The results highlight the critical need for continuous monitoring, cautious antibiotic stewardship, and strict infection control methods to manage and lessen the effects of MDR-AB in ICUs.

Emerging and re-emerging respiratory viruses represent a continuing threat to human health. The pandemic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and influenza A viruses (IAVs) are co-circulating, presenting serious threats to public health. Therefore, screening for safe and broad-spectrum antiviral candidates to control such viral infections is prioritized. Herein, this study reports the in vitro antiviral activity of some essential volatile oils (EOs) and volatile oil components including Peppermint oil, Eucalyptus oil, Clove oil, Thymol, Camphor and Limonin against two different IAVs, namely influenza A/H1N1 and A/H5N1 viruses, and SARS-CoV-2 virus. All tested samples were safe in MDCK and Vero E6 cell lines with CC 50 values that exceed 1 mg/ml, allowing the screening of their antiviral activities using a wide range of concentrations. The results show the potency of Thymol and Limonin against influenza A/H1N1 virus with IC 50 values of 0.022 and 4.25 µg/ml, respectively. The anti-influenza activities of Thymol and Limonin were further validated by testing them against the avian influenza A/H5N1 virus, resulting in anti-influenza activities with IC 50 values of 18.5 and 15.6 ng/ml, respectively. The broad-spectrum potential of the highly potent antiviral candidates, Thymol and Limonin, were further tested against the pandemic SARS-CoV-2 and, both exerted anti-coronavirus activities with IC 50 values of 0.591 and 4.04 µg/ml, respectively. Further investigations against influenza A/H1N1 virus revealed that Thymol and Limonin could inhibit IAV by hindering viral replication. The Biochemical analyses of the interaction of Limonin and Thymol with FDA-approved anti-influenza drug targets, neuraminidase and viral polymerases, revealed that both compounds can partially inhibit IAV polymerase activity, but have no effect on neuraminidase activity. Likely, molecular docking studies indicated that Thymol and Limonin obstruct active binding sites of IAV polymerases. These findings presented on the antiviral activity of Limonin and Thymol might be used to support the development of supplemental therapy against currently emerging and reemerging respiratory viral infections.

As the integration of artificial intelligence (AI) in healthcare delivery becomes increasingly prevalent, understanding the knowledge, attitudes, and practices of health science students towards AI is crucial. However, limited evidence exists regarding the readiness of health science students, particularly in northern Saudi Arabia (KSA), to integrate AI into their future practices, highlighting the need for focused evaluation. We evaluated northern Saudi health science students' knowledge, attitude, practice, and associated factors toward AI. The present cross-sectional study was conducted among 384 health science students aged 18 years and above from Jouf University, KSA. The study employed a validated data collection form with four sections: demographics, knowledge (AI principles and applications), attitudes (perceptions and ethical concerns), and practices (usage and confidence in AI tools). The three domains' scores were categorized as low (<60%), medium (60-80%) and high (>80%) based on their total scores. We utilized Spearman correlation test to ascertain the strength and direction of correlation among each subscale. Additionally, multivariate analysis was employed to identify associated factors. The present study demonstrated low knowledge, attitude, and practices among 55.7%, 37.0%, and 50.3% of health science students. We observed a positive correlation between knowledge and attitude (rho = 0.451, p = 0.001), knowledge and practice (rho = 0.353, p = 0.001), and attitude and practice (rho = 0.651, p = 0.001). Knowledge (p = 0.001) and practice (p = 0.002) were significantly higher among the students who participated in a formal AI training program. Females had a significantly higher level of attitude (p = 0.001) and practice (p = 0.030) than males. In light of these findings, refining the curriculum to incorporate AI emerges as a critical strategy for addressing gaps in AI knowledge, attitudes, and practices among health science students. Therefore, formal and integrated training programs tailored to suit the local setting can effectively prepare health science students to adopt AI technologies in ways that enhance patient care.

Sheet metal parts can often replace milled components, strongly improving the buy-to-fly ratio in the aeronautical sector. However, the sheet metal forming of complex parts traditionally requires expensive tooling, which is usually prohibitive for low manufacturing rates. To achieve precise parts, non-productive and cost-intensive geometry straightening processes are additionally often required after forming. Rollforming is a possible technology for producing profiles at large rates. For low manufacturing rates, robotic rollforming can be an interesting option, significantly reducing investment at the cost of higher manufacturing times while keeping a high process flexibility. Forming is performed incrementally by a single roller set moved by the robot along predefined bending curves. The present work’s contribution to the overall solution is the development of an intelligent algorithm to calculate geometry after a robotic rollforming process based on process reaction forces. This information is required for in-process geometric distortion correction. Reaction forces and torques are acquired during the process, and geometry is calculated based on artificial intelligence (AI) applied to that information. The present paper describes the AI development for this virtual geometry sensing system.

Background Schistosomiasis is a major human disease of public health importance. Freshwater snails serving as intermediary hosts and human interaction with surface water tainted by feces or urine are both necessary components of the transmission cycle. Schistosoma haematobium, Schistosoma mansoni, and Schistosoma japonicum are the primary pathogen species. Over 250 million individuals are infected globally, according to the World Health Organization, causing significant morbidity and an estimated loss of 1.9 million disability‐adjusted life years, a number that is probably underestimated. Immunological protection is slowly built up through complex immunological systems, although innate factors also play a role. Chronic schistosomiasis affects mainly individuals residing in poor rural area. Vaccination is considered as one of the most sustainable options for the control of any pathogen, but schistosomiasis vaccine for humans or animals is not available till now despite the discovery of numerous potentially promising schistosome vaccine antigens. Objective To provide an overview of the schistosomiasis chemotherapy, chemoprevention, and vaccines history and progress. Design Review article. Data Sources PubMed, ISI Web of Science, Science Direct, and the World Health Organization database. Conclusion Favorably praziquantel (PZQ) is a medication with excellent chemopreventive treatment compliance. Due to the extensive usage of PZQ, there is a great deal of debate surrounding the emergence of drug resistance. PZQ is effective against all species of schistosomes, schistosomiasis prevalence has remained largely unaffected, due to reinfection in high transmission areas and growing juvenile worms that were not affected by the drug, even though the need for a schistosomiasis vaccine is even more pressing. Schistosomiasis is a major human disease of public health importance. The goal is to provide an overview of the history and advancements in schistosomiasis chemotherapy, chemoprevention, and vaccine research. Praziquantel is effective against all species of schistosomiasis, but schistosomiasis prevalence has largely remained unaffected, due to reinfection in high transmission areas and growing juvenile worms that were not affected by the drug, even though the need for a schistosomiasis vaccine is made even more pressing.

Type 2 diabetes mellitus (T2DM) impacts various elements of health-related quality of life (HRQoL). However, research on the HRQoL of T2DM patients in primary healthcare settings in Saudi Arabia is limited. Therefore, we aimed to determine the HRQoL and associated factors among patients with T2DM to plan policy-driven interventions and improve patient outcomes. We surveyed 390 patients with T2DM attending primary health centers (PHCs) in the Aljouf province of Saudi Arabia. We included Saudi adults (≥18 years) diagnosed at least six months before the study and completed at least one follow-up visit at the PHC. In the present cross-sectional study, we used the validated 20-item short-form health survey (SF-20)-Arabic tool to assess different HRQoL domains. We performed Mann-Whitney U and Kruskal-Wallis tests for dichotomous and categorical variables, respectively, in each domain. Finally, a binomial logistic regression analysis was performed to determine the predictors of overall HRQoL. The role functioning domain had the highest mean score (75.7±19.7), and the lowest scores were in the social functioning (47.9±20.2) and pain domains (48.9±21.4). Some characteristics, such as marital status, treatment type, and follow-up adherence, were significantly associated with most domains. HRQoL was significantly higher in male patients (p=0.002, adjusted odds ratio [AOR]=2.66) and those on oral hypoglycemic agents (OHAs; p=0.002, AOR=5.18). Obese patients had a significantly lower HRQoL (p=0.036, AOR=0.058). These factors remained significant after adjusting for age, sex, body mass index, treatment type, and comorbidities in the multivariate analysis. We recommend policy changes that incorporate interventions tailored to improve HRQoL, especially in social functioning and pain domains. Moreover, integrating comprehensive pain management strategies and enhancing patient follow-up within PHCs may improve quality of life, especially for high-risk patients with T2DM.

Background Social accountability (SA) within medical education signifies a commitment to address critical regional, societal, and national issues through educational, research, and service activities. In resource-limited regions, marginalized communities face barriers to accessing quality healthcare, and the concept of SA is often poorly understood by students. This study aims to investigate the perspectives, awareness, and comprehension of Syrian medical students regarding the concepts and principles of SA. Methods This cross-sectional online study was conducted in Syria from June 1st to July 25th, 2023, to assess the perspectives on SA among medical students enrolled in pre-clinical and clinical phases from the 3rd to the 6th year, encompassing both stream I and stream II. The questionnaire included three parts: consent and introduction, socio-demographic data, and a 12-item survey assessing social accountability. Data were analyzed using Statistical Package for the Social Sciences software version 24 (SPSS 24). Results A total of 1312 medical students (62.3% females vs. 37.7% males) participated in our analysis. Less than half of the participants (45.7%) reported that their institution had a limited social mission statement regarding the communities they serve. However, only 39.6% reported that their curriculum partially reflected the needs of the population they serve. A mere 7.5% and 6.8% of respondents indicated that their school had excellent community partners and stakeholders shaping their institution, and they learned significantly about other cultures and social circumstances in the medical context through their curriculum. About 24.1% reported that their institution required them to engage in a substantial amount of community-based learning, and 37.4% believed that their class reflected a good representation of socio-demographic characteristics of the reference population. A significant portion of the participants (44.3%) stated that their school did not encourage them to pursue generalist specialties, and 12.7% felt that their institution did not have a positive impact on the community. Among the included participants, 45.8% had some level of SA status, while 37.7% indicated good SA status. Age, gender, and the phase of study were the only sociodemographic characteristics statistically associated with SA status (p-value < 0.05). The association between the 12 items determining SA and the year of study was statistically significant for seven items (p-value < 0.05). However, adjusted logistic regression revealed no significant correlation between predicting SA status and sociodemographic factors (p-value > 0.05). Conclusion This study underscores the significant influence of clinical experience and gender on Syrian medical students’ perceptions of SA. To enhance these perceptions, medical institutions should tailor support services for different stages of training and target initiatives to engage male students.